Clean bill of health but concerns over waste, PPE and handwashing at Edinburgh’s Royal Infirmary

Passed inspection: The Royal Infirmary of Edinburgh

Inspectors from Healthcare Improvement Scotland visited the hospital unannounced on March 9, and focused on issues relating to coronavirus, such as contamination, infection control and hygiene.

Their report found that ‘systems were in place to ensure that patients are assessed prior to admission, to ensure that they are managed within the appropriate pathways and to minimise the risk of transmission of COVID-19 within the hospital’, and said ‘the cleanliness of the environment was good’.

However, inspectors did find some cause for concern regarding the use of PPE and handwashing.

The report reads: “The majority of staff were compliant with the use of PPE and were performing hand hygiene.

“However, we did observe some staff not putting on PPE immediately prior to a care activity and not removing it immediately after.

“Some staff also did not decontaminate their hands after removing gloves.

“In one ward, there were some minor issues with hand hygiene compliance during the mealtime.

“These instances were raised with the nurses in charge at the time of inspection.”

Furthermore, inspectors found that social distancing is not always adhered to.

The report continues: “In two of the small dining areas inspected, we saw some domestic, medical, and allied health professional staff not following the physical distancing guidelines.

“However, during our discussion session, NHS Lothian assured us that reasonable measures to promote physical distancing were in place, the areas are monitored, and that staff are reminded on a regular basis to adhere to the guidelines.”

Inspectors also observed problems with clinical waste removal: “We saw several areas where clinical waste was not stored securely.

“Some ward staff said they had requested additional uplifts of clinical waste due to the increased volume generated during the pandemic, however, the request had not been acted upon.”

Now, NHS Lothian bosses have been told they must take action to improve the use of PPE and the disposal of clinical waste at the hospital.

Ian Smith, head of quality of care at Healthcare Improvement Scotland, said: “During this inspection, we found that the cleanliness of the environment was good.

“Moreover, staff were kept up to date and felt well supported during the COVID-19 pandemic.

“Also, there were clear and effective pathways in place for patients to follow to help minimise the risk of COVID-19 infection.

“However, clinical waste must be stored securely and personal protective equipment – in particular, gloves and aprons – must be worn appropriately by all staff.”

Professor Alex McMahon, nurse director at NHS Lothian, said: “We welcome the report from Healthcare Improvement Scotland and we are pleased it highlighted the high levels of cleanliness within the Royal infirmary of Edinburgh and that it recognises that our staff felt so supported during the COVID-19 pandemic.

“The report also praises the distinct infection prevention and control pathways in operation at the hospital to help protect our patients and staff.

“We are never complacent, however, and we will continue to improve practices, particularly in relation to the requirements around disposal of clinical waste and the use of PPE.

“A range of actions were immediately put in place and to reinforce and remind staff of their vital importance.”

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